Universal Health Coverage

Alistair Burt Excerpts

Wednesday 10th July 2019 Westminster Hall

[Alistair Burt (North East Bedfordshire) (Con)]

I beg to move,

That this House has considered universal health coverage.

It is a great pleasure to serve under your chairmanship again, Mr Robertson, and to be here in Westminster Hall. I am pleased to have the opportunity to say a few words about universal health coverage.

Let me begin with one or two words of thanks. First, I thank Alison Stiby-Harris and, through her, all at Save the Children, which prompted me to seek the debate. I also thank all the colleagues who supported the effort to secure it, and the various agencies and supporters who have contributed to it through their briefings. Secondly, I thank the Library for its briefing pack, which of course is distributed far and wide—far beyond our boundaries. I thank Tim Robinson, Jon Lunn and Philip Brien for their contributions to it.

I also thank my former colleagues at the Department for International Development, who I know will have prepared the Minister for the torrid time he can expect this morning, and with whom I worked so joyfully before Brexit intervened. I thank them and all those they represent, here and around the world, for the immense contribution they make, not only to this area but to all other aspects of aid and development delivery. As I frequently told them and Foreign and Commonwealth Office colleagues around the world, life may be very difficult in some of the spots where they work, but without them things would be just that bit more difficult.

I will first set out the themes of universal healthcare and why I think it is so important, and then offer a few sobering facts and figures about where the world is, and point the way, with reference to what is being done, towards opportunities for the UK to continue to lead in this field, as I hope and believe it can. It is such a vast field that I cannot cover everything.

It is rather nice to start a debate, rather than to have the eight or 10 minutes at the end and have to respond to a veritable volley of questions from Front Benchers and others—not least the hon. Member for Liverpool, West Derby (Stephen Twigg), who we heard with great sadness will not be with us in the next Parliament. No doubt there will be plenty of opportunities to thank him for the contribution he has made. It is nice to have the opportunity to kick off a debate, but I will try to ensure that I do not abuse that privilege by going on until at least half-past 10, as I would love to.

Universal health coverage means that

“all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

That is the World Health Organisation definition, which embodies three related objectives. The first is equity in access to health services. Everyone who needs services, not only those who can afford to pay for them, should get them. Secondly, the quality of health services should be good enough to improve the health of those receiving services. Thirdly, people should be protected against financial risk, ensuring that the cost of using services does not put people at risk of financial harm. Universal health coverage cuts across all the health-related sustainable development goals, particularly SDG 3, and brings hope of better health and protection for the world’s poorest.

I am sure it is not difficult for us to explain to the British public why this topic has such resonance. Health is fundamental. Our nation’s commitment to a national health service, free at the point of delivery, is now such a staple of our lives that its principle needs little further emphasis. So it is around the world.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Gentleman on all he has done in the positions he has held, but it is good to see him leading a debate in Westminster Hall. Tuberculosis is the world’s deadliest infectious disease, killing more people each year than HIV and malaria combined. It affects the most vulnerable and marginalised—those with less money—and both the disease and the treatment have long-lasting consequences. Does he agree that it is imperative that we prevent rather than treat TB, since the latter leads to the emergence and spread of drug resistance, which is a real danger to individuals—especially the vulnerable—and to public health more broadly?

[Alistair Burt]

I am grateful to the hon. Gentleman for that intervention. He is a noble champion of many health causes, and of the rights of people across the world. TB is indeed a key part of the delivery of universal health coverage. I will cover it later in relation to our contribution to the Global Fund, but it is absolutely right that some of the diseases that we have begun effectively to marginalise in the United Kingdom are still a risk in many parts of the world, particularly for the poorest.

A healthy society is one in which children can fulfil their potential, mothers can give birth safely and the cruellest of preventable diseases, such as TB, can be tackled, with life and nation-changing impact, but to do this effectively, the world needs to tackle it collectively. Colleagues will know how important I hold collective multilateral activity by the world’s nations to be. As multilateralism seems under relentless threat from many quarters, universal health coverage reminds us that a common issue or threat is dealt with not by even the best-intentioned individual or bilateral action, but by pooling sovereignty and making collective effort, whether that is in vaccination, in the fight against HIV/AIDS, or in combating anti-microbial resistance. Collective effort also means creating partnerships between the public, private, and charitable and voluntary sectors, which all have a place. Efforts to exclude, or to advocate exclusivity for, one or other of those sectors need examining very carefully.

[Jim Shannon]

I thank the right hon. Gentleman for giving way again; he is being most generous. On collective responses, the UN’s high-level meeting on universal health coverage must build on the success of last year’s UN high-level meeting on TB and reaffirm the commitment to diagnose and treat 40 million people with TB by 2022. Does he agree that though our commitment to the Global Fund is a great first step by this Government and the United Kingdom of Great Britain and Northern Ireland, we need others to give the same commitment?

[Alistair Burt]

Indeed. Once again, the hon. Gentleman anticipates something I will come to later. Our 16% uplift in relation to the Global Fund is remarkable in itself, but of course it should be an example to others.

Efforts to build sustainability and to encourage and work towards health system strengthening around the world are really important. Although there will always be a need to respond to outbreaks or emergencies, basic healthcare and steady improvement are achieved not by continual external intervention, but by dedicated work to build, train and equip those who take national responsibility for their nation’s health. A DFID brief puts it as follows:

“Countries need strong health systems if they are to achieve Global Goal 3, and ‘ensure healthy lives and promote well-being for all ages’”—

that is SDG 3—

“and the target of UHC aimed at reaching the most excluded and living in the most remote locations, leaving ‘no one behind’.”

That determination to ensure that responsibility for health is rightly taken by a nation itself, and our view that our role is to enable such a transition in health to take place, helps us to explain in this country why UK aid and development assistance works, and why our commitment to spending 0.7% of gross national income is so important. Few question the role the UK plays in immunising millions of children around the world, including some 8 million victims of the war in Syria.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Something like 5 million refugees from the Syrian conflict are in camps in the countries around Syria. Will the right hon. Gentleman reflect on the impact on the physical and mental health of people of all ages, particularly the 1.5 million children, of being in camps, rather than in settled communities, often for many years?

[Alistair Burt]

We could spend another 20 minutes reflecting deeply on that. Like others in the Chamber, I have had the good fortune to visit refugees in various locations. Some are in camps. The majority in Lebanon, for example, where a quarter of the population are Syrian refugees, live on the outskirts of other communities. The hon. Gentleman is absolutely correct.

Although, understandably, there used to be a concentration on the basic needs—shelter, food and water—there is now a clear recognition of the damage that is done, particularly but not exclusively to children, over a longer period. Of course, one area of concern is education. It is reckoned that perhaps a third of refugee children lose primary education, and perhaps two thirds lose secondary education. There are also the limitations on their action and the impact of that on mental health. Some time ago, the UK and DFID stopped seeing mental health as a nice add-on to support and saw it as essential. We have put money, effort and support into putting workers in to protect against mental health problems.

Of course, if the wars were not occurring, such problems would not be there. That encourages us to redouble our efforts in conflict prevention and peacebuilding in the areas most at risk.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Is the right hon. Gentleman aware that more than 5.6 million children under the age of five die from preventable diseases every year? Does he agree that immunisation is a critical backbone of any universal health strategy?

[Alistair Burt]

I do, and I may say something further about vaccination in just a moment. The hon. Gentleman is absolutely right.

[David Simpson (Upper Bann) (DUP)]

Alongside the health and mental health issues of young people, there is grave concern in many countries about the trafficking of children and young people in camps and outside. Does the right hon. Gentleman agree—I am sure he will—that that also needs to be addressed?

[Alistair Burt]

Yes, the hon. Gentleman is correct. When I was in the main camp in Cox’s Bazar—colleagues will have visited it—with those who had been there a year, protected from the atrocities in Burma, I asked, “What happens next?”. I was told the biggest worries on the camp were: boredom and lack of things to do; education for the children; domestic abuse in the camp; and trafficking. That is a signal to all of us that just keeping people in a camp, protecting them from one thing but leaving them exposed to another, is a further tragedy.

Let us look at the state of the world’s health, concentrating on three areas in particular. The first is children’s health, where the picture is not all gloomy. Each day, 17,000 fewer children die than did in 1990, but more than 5 million children still die before their fifth birthday each year. Since 2000, measles vaccines have averted nearly 15.6 million deaths. Despite determined global progress, an increasing proportion of child deaths are in sub-Saharan Africa and southern Asia; four out of five deaths of children under five occur in those regions. Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families.

Secondly, let us look at maternal health. Maternal mortality has fallen by 37% since 2000. In eastern Asia, northern Africa and southern Asia, it has declined by about two thirds, but the maternal mortality ratio—the proportion of mothers who do not survive childbirth—in developing regions is still 14 times that of developed regions. The need for family planning is slowly being met for more women, but demand is increasing rapidly. Again, we see that in the camps, where women who, in the countries they come from, had been excluded from reproductive health advice, perhaps for religious reasons, gain rapid access to it in the camps. That again is a lesson for the future.

Thirdly, I turn to HIV/AIDS, malaria and other diseases. In 2017, 36.9 million people globally were living with HIV, and 21.7 million people were accessing antiretroviral therapy, but 1.8 million people became newly infected with HIV and 940,000 people died from AIDS-related illnesses in that year. TB remains the leading cause of death among people living with HIV, accounting for about one in three AIDS-related deaths. Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which puts them at increased risk of acquiring HIV. It is the leading cause of death for women of reproductive age worldwide, and now the leading cause of death among adolescents in Africa, and the second most common cause of death among adolescents globally.

More than 6.2 million malaria deaths were averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global incidence of malaria has fallen by an estimated 37% and mortality by 58%.

What is DFID doing in these areas, and where are we going? The UK’s significant boost to the Global Fund, the combined effort to combat AIDS, TB and malaria, was announced by Prime Minister at the recent Japan summit. The 16% increase to our already generous contribution sets a new standard for others to follow, and I thank the Minister and all those behind him who worked on that over a long period. My friends at STOPAIDS and ONE and many others welcomed the achievement. ONE said:

“This is global Britain in action.”

There’s a phrase! It continued:

“It is fantastic to see the UK reaffirming its position as global health leader, working in partnership with other donors, countries affected by the diseases, the private sector and philanthropy to make the world a safe, and healthier place”.

However, we must ask the Minister how he plans to ensure that others follow. Will he outline any changes or developments in transition strategies, as nations take on more of their own responsibilities and work towards what, in such areas, is often a difficult process?

Let me say a few words about vaccination. Gavi, created in 2000, is a global vaccine alliance bringing together the public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries. From 2016 to 2020, the UK is providing a quarter of Gavi’s funds. We are its largest donor, and have supported it since its inception. Gavi’s first replenishment conference was hosted by David Cameron in London in 2011.

As well as providing direct funding to Gavi, the UK was also instrumental in creating the international finance facility for immunisation, which raises funds for Gavi by issuing vaccine bonds on international capital markets. The UK also helped create the advanced market commitment for pneumococcal vaccines, which have helped protect millions of children in developing countries against the leading cause of pneumonia, as well as the matching fund, which encourages funding from the private and philanthropic sectors by doubling donations. That is my point about partnerships. It is always tempting to think that this work can be done by one sector or another alone. My experience is that that is not the case. Partnerships can contribute to the whole, but they need to be handled carefully.

Let me mention polio. As we know, it has decreased by over 99% since 1988, but transmission has never stopped in three countries: Pakistan, Afghanistan and Nigeria. There remains a risk of failure. We must thank the development and health workers who are responsible for vaccination. In particular, we recognise that in some countries they face genuine physical threats and loss of life.

In other countries, vaccination faces a threat from anti-vaccination campaigns, which are run for all sorts of reasons. It is essential that anti-science is combated by evidence of science and evidence of success. As far as I am aware, vaccination is about Edward Jenner and smallpox in the United Kingdom, and about Pasteur and others worldwide. It is not about big pharma trying to sell vaccines; it is a proven method of saving countless millions of lives. As we have learned to our cost, we might find a good argument lost for want of it not being made regularly. Let that not happen with vaccination.

Finally on polio, I must mention rotary. I am an honorary member of the Sandy rotary club—my father has been a member of the Bedford rotary club and Bury rotary club for many years—and we recognise that rotary has helped vaccinate 2.5 billion people in 122 different countries and given more than £1.8 billion over 30 years. I have met Judith Diment, the national representative, a number of times. We thank those in rotary up and down the country and abroad for their efforts and voluntary work.

Finally, on behalf of Save the Children and others who have written to me on this issue, I turn briefly to the high-level meeting. The first ever high-level meeting on universal health coverage will take place in September at the UN General Assembly. It is a critical opportunity to galvanise global momentum behind healthcare.

“The theme…is ‘Universal Health Coverage: Moving Together to Build a Healthier World.’ This…will be the last chance before 2023, the mid-point of the SDGs, to mobilise the highest political support to package the entire health agenda under the umbrella of UHC, and sustain health investments in a harmonised manner.”

I am shamefully reading out the briefing from Save the Children. I am not pretending to claim authorship of this; I am acknowledging the support we get from our remarkable partners. The high-level meeting has the potential to be a transformational moment for children everywhere, but countries need to step up their efforts to tackle the biggest challenges in global health today, from ending the scourge of preventable diseases to reigniting action on stalled global immunisation rates, for the reasons I mentioned.

I know the Minister will have been presented with a series of challenges for the high-level meeting. Perhaps I could outline them. We hope that the Secretary of State will attend the high-level meeting. The UK should champion free-at-the-point-of-use health and nutrition provision, helping to deliver on the “leave no one behind” agenda and to ensure that we reach those furthest behind; it should signal its support for domestic resource mobilisation, which is essential for encouraging more countries to work on strengthening their systems; it should champion the full integration of nutrition and immunisation into national universal health coverage plans; and it should fund UHC2030 as the main institution that can make a difference in driving the UHC agenda and on accountability, with a focus on meaningful civil society participation.

I could mention much more. Sexual and reproductive health is vital. At the 2017 summit, we announced £250 million of support over the next four years. Access to sexual and reproductive health services is under increasing threat from some developed nations that ought to know better. It is essential that the United Kingdom follows its independent path, and is not browbeaten by any of its larger partners or friends into offering restrictive reproductive health facilities just because somebody else does not like them, for questionable reasons.

We must continue the work on neglected tropical diseases. We are protecting some 200 million people from 2017 to 2022 with support of £360 million. I have not mentioned anti-microbial resistance and the work of Sally Davies. She moves on from her post relatively soon, and we should thank her warmly for all the vital work she has been able to do. Ultimately, it will protect us all; if we cannot find answers, that threatens us all. I thank those involved in the collaborative work that we now do internationally with the Department of Health and Social Care, and I hope the Minister will be able to take that work further.

I could mention the contribution of water sanitation and hygiene—the foundation for good health. I have seen remarkable projects that the United Kingdom is doing around the world on that. There is no point having a global health system or a national health system if there is no effective sanitation. It makes a particular difference to young women at important stages in their lives. It is absolutely essential. Nutrition, one of my favourite subjects in the Department, is much underrated. It is really vital to ensure that nutrition is correctly promoted. There is a difference between feeding people and feeding them nutritiously, as I learned in my first week in DFID.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Should we not also emphasise that vaccines will not work properly on a malnourished child? We need to see these subjects as two sides of the same coin.

[Alistair Burt]

The hon. Lady is absolutely right and speaks with great experience. A child may be physically alive, but the weaker a child becomes through lack of nutrition, or through existing on the barest rations, the more prone they are to disease, and the harder it is to ensure that preventive measures work. That is absolutely correct.

I wonder whether the Minister wants to venture an opinion on the Department for International Development remaining a stand-alone Department. It might be slightly unfair to expect an answer from him on that, but I hope that this debate will leave him in no doubt of the value that we see in an independent-minded DFID. It is always part of the Government, as I occasionally had to remind officials, but it very much has its own stand- alone processes.

I hope others will cover all those points, and that I have helped to lay the ground, and made it clear how important this House feels universal health coverage is, and how proud we are of the United Kingdom’s previous contribution and its determination to keep that up. There is a clear sense that we are a world leader, through the work of our hard-working experts. The Minister should know that he has the full backing of the House in his determination to make sure that this issue remains as important to him as it has been to me and all my predecessors.

[Several hon. Members rose—]

--- Later in debate ---

[The Minister of State, Department for International Development (Dr Andrew Murrison)]

I congratulate all involved today on an excellent debate. It is timely because on 23 September we will be discussing universal health coverage at the high-level meeting in New York.

I am pleased to have heard almost universal praise from across the House for the advance declaration that the UK has made in relation to the Global Fund. I am proud of that, and I hope everybody here is proud of it too. Not only is it a significant sum of money and an uplift to what we were spending before, but when taken with the other Global Funds, it propels us to the top of the league table of international development, particularly relating to healthcare.

It is more important still because it is advance notification. The whole point is to encourage others to pledge and commit—the two are slightly different—generous funds aimed at dealing with the healthcare issues we all struggle with, because we are all in this together, particularly in relation to infectious disease. That point has been made by a number of right hon. and hon. Members, because infectious diseases respect no borders.

Having started on a positive note, may I introduce an element of gloom? Strategic development goal 3 and the 17 development goals related to it are not on track to be successfully rolled out. Universal health coverage is an aspiration, but it is not secure; the glass is indeed half empty.

I congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt). It is ironic that I am here potentially answering for decisions that he made in Government.

[Alistair Burt]

All good ones.

[Dr Murrison]

I was about to say that I am really comfortable to do so, because the decisions he made, and those he is associated with vicariously, are good ones. I am happy to have inherited his portfolio, but he is a difficult act to follow, that is for sure.

My right hon. Friend identified all the issues in his contribution, as I would expect him to do. He started by highlighting universal health coverage and its contribution to SDG 3, but he also made the point that universal health coverage touches on the other SDGs as well. In advance of the high-level meeting on 23 September, he was right to ask about the aims and ambitions the UK Government have for that meeting. They are encapsulated in getting more money—obviously—and getting better quality and integrated healthcare. That is something many of the contributions have touched on one way or another. I have been struck by the level of support for an holistic approach to delivering universal healthcare.

We have talked about immunisation and about the mistake we would be making if we simply imagined that going around the world offering people vaccinations and inoculations would be “job done”. It really would not be. Those interventions would be treated with a great deal of suspicion by communities, as they are at the moment, if that were all we were offering. It has to be much more than that; it truly has to be integrated. I look forward to making this point loud and clear in September in New York.

On a broader theme, as I have gone around the world, I have been struck by the roll-out of healthcare systems. Very often, there is a temptation for politicians to roll out shiny things that they can demonstrate to their constituents. That generally means hospitals, and hospitals are great things, but they may not be the right thing in low and middle-income countries.

--- Later in debate ---

[Alistair Burt]

It is a pleasure to briefly conclude the debate and to thank all those who took part for the contributions they made in a variety of ways. The hon. Members for Birmingham, Edgbaston (Preet Kaur Gill) and for Dundee West (Chris Law), speaking from the Front Bench, ensured that I was not far wrong when I spoke about the Minister having a torrid time. Theirs were thoughtful contributions that will remind the Minister that his post is not an easy wicket all the time. There are serious questions to be asked about development, and they were well asked, as always. My right hon. Friend responded very well. I thank him for his generous remarks and his response to the debate. We can all feel that the matter is in good hands.

I thank colleagues—the hon. Members for Glasgow East (David Linden), for Lincoln (Karen Lee) and for Central Ayrshire (Dr Whitford)—for the variety of contributions they made. The hon. Member for Central Ayrshire always speaks with great authority in such debates, and she reminded us about complacency and how things that we take for granted can easily be lost. My hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) reminded us of the efficacy of small charities, and he was ably supported by my hon. Friend the Member for Stafford (Jeremy Lefroy), who is quite a champion of their work in many parts of the world. He speaks with great knowledge about that.

We shall miss the hon. Member for Liverpool, West Derby (Stephen Twigg), who is a thoughtful critic. He is always good at supporting the good things that the United Kingdom does, but keen to press the point where things are not right and to move us in the right direction. He has made a significant contribution, and his reputation across the House and beyond is well deserved. However long we are all here, I know he will continue to add to that.

I want to say a brief word about the conundrum that is the United States. On the one hand, it is the most extraordinarily generous contributor to the world—billions of dollars flow from it. There is a great risk of confusing the United States in general with elements of the Administration, and that would be unfair. We all work with colleagues in America who are the most generous and gifted of individuals. There will be the odd clash with an Administration of any sort, particularly at the moment. We have to be careful. The American Government are themselves a significant donor. There is a conundrum, and there are areas where we will challenge, but we must be careful that that does not tip over into unwarranted criticism.

In relation to partnerships that need to be created—I noticed the emphasis placed by the hon. Member for Birmingham, Edgbaston on public systems—medicine and health cannot work without a partnership between the private, the public and philanthropy. With the sheer scale of what is available, and the ability of the private sector to make a contribution, the skill is to use that effectively to ensure that the poorest, and those in the most difficult locations and with neglected conditions, are still brought in. That is where political skills can be exercised. We have a role to play.

The gist of the debate was about focusing on what is meant by universal health coverage and about looking ahead to the meeting in September. If there is any part of my former role that I miss, it is UNGA week. I did 60 engagements in four days; that was my best. I sincerely hope that the Minister will be well used and well worked. It is an opportunity for him to see all the people involved and to make the contributions he needs to, and for the UK to lead by example. Because he represents DFID, he will find, as I did, that he is received everywhere he goes—he will be standing on the shoulders of all those who work for DFID—in a way that would warm anyone’s heart.

This is about a partnership, with people in the UK working hard for something that DFID and Ministers deliver at top level. As we head towards the high-level meeting, I know the Minister will be determined to ensure that the global leadership continues, and that the example is set. We will all do our best to contribute to the good things, to mount challenges when that is needed, and to give praise when it is deserved. We need to stay in the forefront in relation to what the world needs. We know that the problems are not going away, and that the challenge, and the need for determination, will continue for some time.

Question put and agreed to.

Resolved,

That this House has considered universal health coverage.